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目的探讨湿化高流量鼻导管通气(HHFNC)的应用效果和安全性。方法选择2012年1~12月本院新生儿重症监护中心收治的胎龄<34周且出生体重<1500 g的Ⅲ~Ⅳ级呼吸窘迫综合征(RDS)患儿,患儿撤机后随机分为HHFNC组和经鼻持续气道正压通气(NCPAP)组,比较两组患儿的鼻部损伤发生率、重新气管插管率、气漏及支气管肺发育不良发生率、病死率以及撤机时间、住院时间、呼吸机治疗费用等。结果和NCPAP组相比,HHFNC组鼻损伤较少[1/28(3.6%)比8/31(25.8%),P<0.05],呼吸机治疗费用也较低[(5.8±1.9)千元比(8.6±1.8)千元,P<0.01]。两组患儿的病死率、重新插管率、应用NCPAP/HHFNC后1 h的PaO2和PCO2值、撤机时间、机械通气时间、住院时间以及气漏、支气管肺发育不良、坏死性小肠结肠炎、严重脑室内出血、早产儿视网膜病发生率等差异均无统计学意义(P>0.05)。结论 HHFNC是一种容易被接受且效果良好的早产儿呼吸支持方式,其潜在优势包括简便、容易耐受、较少鼻部损伤、成本更低,更便于推广。
Objective To investigate the effect and safety of humidified high flow nasal catheter ventilation (HHFNC). Methods From January to December 2012, children with grade Ⅲ ~ Ⅳ respiratory distress syndrome (RDS) at gestational age <34 weeks and birth weight <1500 g were enrolled in our neonatal intensive care center. All patients were randomly divided For the HHFNC group and nasal continuous positive airway pressure (NCPAP) group, compared the incidence of nasal injury, re-tracheal intubation rate, air leak and bronchopulmonary dysplasia, mortality and weaning Time, hospital stay, ventilator treatment costs. Results In the HHFNC group, there were fewer nasal lesions (1/28 (3.6%) vs. 8/31 (25.8%), P <0.05], and ventilator costs were lower (5.8 ± 1.9) (8.6 ± 1.8) thousand yuan, P <0.01]. Mortality, re-intubation rates, PaO2 and PCO2 values at 1 h after NCPAP / HHFNC administration, weaning time, mechanical ventilation time, hospital stay, and air leaks, bronchopulmonary dysplasia, necrotizing enterocolitis , Severe intraventricular hemorrhage, the incidence of retinopathy of prematurity and other differences were not statistically significant (P> 0.05). Conclusions HHFNC is an easily accepted and well-acting respiratory supportive model for preterm infants with potential advantages of ease and tolerability, less nasal damage, lower cost and ease of dissemination.